Regenerative Medicine: A Holistic Approach for Musculoskeletal & Peripheral Vascular Disorders
That regenerative medicine is a holistic practice implies that regenerative medicine techniques for musculoskeletal and peripheral vascular disorders are both available and effective. That is true. Adding a holistic approach is another step in the process that helps your body move forward on a healing path.
Numerous forms of regenerative medicine exist. From a musculoskeletal and peripheral vascular perspective the first step should embrace the importance of nutrition. While several procedures are available to enhance cell regeneration none of them will be as effective if the body is nutritionally deficient. While numerous supplements are available, we recommend Juice Plus. This is a whole food fruits and vegetable extract with several medical school studies that demonstrate Juice Plus absorption and cell integration of the underlying nutrients.
Before regenerative medicine techniques are initiated it is best to have a medical doctor evaluate the root cause of the problem. Often underlying conditions are present that affect healing. For example, a patient with diabetes or early peripheral arterial disease will not heal as quickly as someone without those conditions. Medical management to obtain optimal control of co morbid disease can only enhance a regenerative medicine approach.
Likewise a torn rotator cuff in the shoulder or an osteoarthritic knee may be associated with a strained ligament in the neck or a nerve irritation in the low back. Quite often treating the spinal component will improve the results of treating the injured limb. That means the whole body should be evaluated, not just the area of most obvious interest. If muscles are inhibited, tight or weak a functional restoration program to re educate, stretch and then strengthen should occur.
Diagnostic Musculoskeletal Ultrasound, Segmental Plethysmography, and Arterial Duplex studies are three non invasive and non ionizing tests that can both image and detect the presence of injury or disease. Depending upon the severity of findings results can be used to formulate a focused treatment plan. A very powerful tool to re-grow, or proliferate torn or stretched muscle, tendon and ligament is Prolotherapy.
Prolotherapy is a technique where medications are injected into an injured musculoskeletal body part with the intent of regenerating tissue. Various compounds are used, but we prefer a combination of Xylocaine and Sodium Morrhuate. Morruate is 80% arachandonic acid. When injected into the injured body part it stimulates local prostaglandin production, which in turn initiates the wound healing cascade.
Essentially Prolotherapy is a natural way of telling your body’s natural wound healing response to come to an area and to it. Injections are often done an average of three times over a several weeks. Biopsies have been done and confirm the creation of organized tissue (not scar formation). After the third injection a 40% thickening can be expected.
For more severe cases, or in instances where a faster response is needed, PRP can be done. In this instance Platelet Rich Plasma (concentrated growth factors from your own blood) are injected into the injured tissue. Unlike prolotherapy that tells your body’s natural wound healing response to come to an area, PRP concentrates those cells involved in wound healing and puts them into the area. Usually only one or two injections are needed. While there can be more pain right after the injection it is usually short lived and followed by rapid improvement.
Placed in between PRP and Stem Cell therapy are concentrated growth factors that are obtained from donor sources such as amnion (the inner most layer of the placenta) or from the placenta itself. When tissue or growth factors are obtained from sources other then your own body they are called allografts. While some biologic companies that provide placenta derived growth factors have studies that show their products contain stem cells most claims from this class of products are restricted to containing growth factors only. The FDA closely monitors the process whenever biologics such as these are used to help assure that strict safety standards are met. Nice things about allograft growth factor treatments include relative ease of administration, they usually only need to be done one time, and they cause little pain during the procedure.
Even more advanced regenerative techniques include obtaining “stem cells” from bone marrow or fatty tissue (when the cells come from your own body they are referred to as autologus grafts), or umbilical cord derived sources. The goal for both autologus and allograft stem cell therapy is to provide a high concentration of undifferentiated cells (cells that have not yet decided what they want to be). Harvesting and preparing stem cells from bone marrow or fat cells requires a minor surgical procedure (either bone marrow aspiration or liposuction) so the technology needed to obtain these cells, and then to concentrate them, is more involved for the patient versus getting cells from allograft sources. That also means that the cost for autologus stem cells is higher and there is generally some pain when the tissue is taken (in most cases this is well controlled however some discomfort should be expected). When stem cells come from other donors as is the case with umbilical cord derived sources there is little or no pain associated with the procedure since only a graft is required. With each step up from proliferative injections to stem cell treatment the cost is higher and the response is expected to be more robust.
It is readily accepted that PRP and Stem Cell therapies can regenerate ligament and facilitate muscle & tendon healing. Cartilage restoration is a bit more controversial. Most physicians that perform regenerative medicine treatments however agree that when stem cells are employed the clinical response looks very much like new cartilage was laid down. With the exception of select cancer and wound or peripheral vascular conditions while there have been exciting reports of stem cell treatments resulting in miraculous responses in a wide range of medical conditions for the most part these other indications are not yet readily accepted by the medical community. Our office has published in the past on reversal of peripheral vascular disease when nutritional support (Juice Plus) is combined with medications such as Plavix and Pletal. We have seen excellent responses in wound and peripheral vascular cases using PRP or Stem Cell this approach in our opinion they are still not the main stay of treatment and experience remains anecdotal.
Reducing total load means doing whatever is necessary to put the body back onto a healing path. In an effort to maximize outcomes we like to help you and your body do what ever is necessary to facilitate the best outcome. That means looking at all the factors that affect wellness and doing whatever else is necessary too support your musculoskeletal system and the joint or tissue we are trying to treat. Some patients may even benefit from treatment with hormone replacement therapy, infectious and immunological approaches, or addressing mind body spirit challenges. We try to be open minded in our approach and provide only those treatments that make sense for you. Whether you suffer from sprained, strained or partially torn muscle, tendon, ligament, or have joint space narrowing associated with osteoarthritis, regenerative medicine offers new treatment options for restoring quality of life.